- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,477.80 / $21,024.60 / $29,768.60
| Facility | | $11,477.80 | $21,024.60 | $29,768.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,509.11 / $18,790.00 / $29,511.93
| Facility | | $11,509.11 | $18,790.00 | $29,511.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,933.46 / $18,912.73 / $33,648.74
| Facility | | $11,933.46 | $18,912.73 | $33,648.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $17,662.66 / $39,789.69
| Facility | | $7,117.00 | $17,662.66 | $39,789.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $17,455.40 / $35,359.19
| Facility | | $3,308.00 | $17,455.40 | $35,359.19 |